Day Case Surgery
Day case surgery is the admission of selected patients to hospital for a planned surgical procedure, returning home on the same day. They represent about 70% of all surgery in the UK.
Surgical day cases have been identified as the number one high-impact change to improve productivity in the UK NHS – with a target of “treating day surgery (rather than inpatient surgery) as the norm for elective surgery”.
The advantages of day case surgery are:
- Shorter inpatient stays
- Reduced waiting lists
- Lower infection rates
- Cheaper than surgery requiring an overnight stay
In this article, we shall look at patient selection for day case surgery, the types of procedures that are suitable, and how to prepare a patient as a surgical day case.
Preparing for Day Case
A patient undergoing a day case procedure should be advised not to eat and drink for the 6 hours leading up to surgery (when involving a general anaesthetic). Many departments will allow a patient to drink small volumes of water up to 2 hours before a general anaesthetic and local guidelines should be adhered to.
Medications should be checked to ensure that they will not interfere with the planned surgery and guidance is sometimes necessary from the operating surgeon. In general, most medications may be continued up to the day of the operation, including the day of the procedure. However, special care should be taken over certain classes of medication, such as anti-coagulants (+/- anti-platelets) in operations where bleeding is a risk.
Types of Day Case Surgery
For a surgical procedure to be considered for day case surgery, it must meet the following criteria:
- Minimal blood loss expected
- Short operating time (<1 hour)
- No expected intra-operative or post-operative complications
- No requirement for specialist aftercare.
Examples of day case surgical procedures are shown below.
|Procedure||Current Day Case Rate (%)|
|Termination of pregnancy||89.0|
|Extraction of wisdom tooth||87.9|
Selection of the Patient
Much of the success of day-case surgery is down to care in patient selection. In the UK, most hospitals follow local guidelines to aid in this – these generally include absolute and relative contraindications based on co-morbidities.
The selection of a patient for day surgery should be based upon social and medical factors:
- Social factors – a patient must understand the planned procedure, consent appropriately, and understand the following post-operative care.
- The patient should also have sufficient provisions to have a responsible adult escort them home, and provide support for the first 24 hours of post-operative care.
- Medical factors – a patient’s health must be suitable for a day case procedure, remembering that some stable chronic diseases (e.g. DM or asthma) can often be better managed as a day procedure to minimise any disruption to their daily routine
Note: Whilst ASA status, age, and BMI will all lend towards determining a stance on a patient’s degree of health, these should not be solely used in making such a decision.